Effect of Open Glottis versus closed Glottis (Valsalva) in Second Stage of Labor on Maternal and Neonatal Outcomes

Soliman Ahmed Mohamed, Safaa; Nasr Eldeen Elsadek, Abeer; M Khalil, Eman; Kamal Helmy, Hanaa

doi:10.21608/ejhc.2022.226064

Effect of Open Glottis versus closed Glottis (Valsalva) in Second Stage of Labor on Maternal and Neonatal Outcomes

Document Type : Original Article

Authors

¹ Assistant Professor of Maternal and Neonatal Health Nursing Beni-sueif University, Egypt

² Lecturer of Maternal and Neonatal Health Nursing Beni-sueif University, Egypt

³ Lecturer of Obstetrics &Gynecology, Faculty of Medicine Beni-sueif University, Egypt

10.21608/ejhc.2022.226064

Abstract

Background: Maternal pushing during the second stage of labor is crucial and important
contributor to the involuntary expulsive force developed by uterine contraction results to
influence on the mother and fetus. Aim: the study was conducted to compare between the
effect of open glottis versus closed glottis (valsalva) in second stage of labor on maternal and
neonatal outcomes. Methods: Setting: Delivery Unit of Beni-suef University Hospitals.
Design: A quasi-experimental comparative study. Subjects: A purposive sample of a total of
150 primiparous women; 75 in the Open Glottis group& 75 in the closed glottis (Valsalva)
group. Tools: four tools were used; structured interviewing questionnaire , Apgar score,
Visual analog scale, and women satisfaction questionnaire. Results: The duration of the 2nd
stage of labor was shorter (5-10 min) in a open glottis (spontaneous) (54.0%) group compared
to the closed glottis pushing group (2.0%). Oxygen wasn't used at all in open glottis pushing
group compared to 74.0% of closed glottis pushing group. postpartum hemorrhage was too
little in open glottis pushing group (96.0%) compared to 36.0% of the closed glottis pushing
group. Also, all women in the open glottis pushing group experienced mild perineal pain
compared to 32.0% in the directed pushing group (p < 0.001). The individual items of the VAS
were significantly higher in the closed glottis pushing group than those in the open glottis
pushing group. According to Apgar's score, there was a significant difference between the two
groups during both the first and fifth minutes of birth. In the closed glottis pushing group, a
higher proportion of babies are admitted to ICU than those in the open glottis pushing group
(18.0 percent versus 10.0 percent). Conclusion; open glottis pushing during the 2nd stage of
labor enhanced neonatal and maternal outcomes; whilst closed glottis pushing was associated
with an increased duration of the 2nd stage of labor, risk of adverse neonatal outcomes and the
postpartum hemorrhage was too little in open glottis pushing group. Recommendations: It
may be recommended that open glottis pushing during the second stage of childbirth be
included in the procedure for maternal hospitals

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